Iowa Supreme Court Attorney Disciplinary Board Complaint Form (current as of 4/1/2016, see Iowa Court Rule 35.15) Complete a separate form for each attorney with whom you have a complaint. 1. _________________________________________ _______________________________________ _____ _________ State ZIP code (____)____________________ Business phone Your name Email address _______________________________________ ____________________ Street address City (____)____________________ (____)____________________ Home phone Cell phone 2. Name of attorney about whom you are complaining: _______________________________________ Business address (____)____________________ Business phone _______________________________________ _____ State _________ ZIP code Name ____________________ City 3. Did you hire the attorney? Check one Yes No If yes, when did you hire the attorney? _______________________________________ If no, what is your connection to the attorney? ____________________________________________ ___________________________________________________________________________________ 4. If your complaint is about a lawsuit or court case, answer the following: A. Name of court: ___________________________________________________________ Examples: Iowa District Court for Polk County; United States District Court for Northern District of Iowa B. Case title: ___________________________________________________________ Examples: Smith vs. Jones; State vs. Doe C. Case no. ___________________________________ 5. Type or write neatly on one or more separate sheets of paper a detailed factual statement of what the attorney did or did not do. Return the sheet(s) with this form. Write on only one side of the complaint form and the additional sheets of paper. Attach copies of documents that prove or help to explain your complaint, such as fee agreements, letters, checks, receipts, itemized billings, and court papers. Send only copies, not original documents, as we are not able to return your documents to you. In filing this complaint, you are waiving confidentiality and attorney-client privileges, if any, between you and the attorney named above. This waiver allows the attorney to disclose your confidential information to the extent reasonably necessary to respond to the complaint. 6. Oath and Signature I , __________________________________ , certify under penalty of perjury and pursuant to the laws Print your name of the State of Iowa that the allegations of this complaint are true and correct. ___________________________ Month __________, 20______ Day Year ______________________________ Your Signature Send the completed form to: Iowa Supreme Court Attorney Disciplinary Board Iowa Judicial Branch Building 1111 East Court Avenue Des Moines, Iowa 50319 Telephone (515) 725-8017 American LegalNet, Inc. www.FormsWorkFlow.com